Using Medicaid to Expand Programs of Assertive Community Treatment

NAMI supports implementation of treatment programs that are based on research evidence. Assertive community treatment is endorsed by the National Institute of Mental Health as an effective, evidence-based, outreach oriented treatment, rehabilitation and support model. Using a recovery oriented, 24-hour-a-day, seven-day-a-week, multi-disciplinary team approach, programs of assertive community treatment (PACT) delivers comprehensive community treatment. Importantly, the PACT team directly provides both psychiatric and substance abuse treatment: PACT is an integrated treatment approach. Over thirty years of research on assertive community treatment documents positive community outcomes for the ten to twenty percent of people most severely disabled by mental illnesses.

A June 1999 letter from the Director of the Center for Medicaid and State Operations at the federal Health Care Financing Administration (HCFA) advises states that assertive community treatment is superior to conventional case management for those most ill. Assertive community treatment services can be funded by Medicaid. The HCFA advisory goes onto urge, "States should consider this recommendation in their plans for comprehensive approaches to community based mental health services."

Nevertheless, efforts by states to finance PACT services through the Medicaid program have been complicated in recent years by the confusing and often conflicting rules in federal Medicaid law. While many of the services that are central to the PACT model are part of the menu of services states can offer in their Medicaid programs under the federal "Rehabilitation Option," few states have elected to integrate PACT as a distinct service. Because of this confusion, NAMI believes that changes are needed to federal Medicaid law to assist states wishing to implement the PACT program and make it available to Medicaid recipients with severe mental illnesses.

For more information about NAMI’s activities on this issue, please call Elizabeth Edgar at 703/516-7973, or Andrew Sperling at 703-516-7222. All media representatives, please call NAMI’s communications staff at 703/516-7963.